There was a 70 percent decrease in cervical cancer deaths
from 1955 to 1972, largely as a result of the Pap test ( 31).
Technique Prevents Removes
Colectomy* Colon Cancer Part of large intestine
Hysterectomy* Uterine Cancer Uterus
Mastectomy Breast Cancer Breasts
Oophorectomy Ovarian Cancer Ovaries
Orchiectomy* Testicular Cancer and Testes
Salpingo- Ovarian Cancer Ovaries and
oophorectomy fallopian tubes
Table 7: Surgeries for the Prevention of Cancer
*not commonly performed for the prevention of cancer
USPSTF Cancer Screening
The U.S. Preventive Services Task Force (USPSTF) is an
independent group of experts that makes evidence-based
recommendations about clinical preventive services such as
screenings, counseling services, or preventive medications.
Importantly, recommendations can be revised if research
uncovers new evidence.
The USPSTF has made numerous recommendations related
to population-based screening for early detection of several
cancers. Here we highlight its recommendations, as of Aug. 1,
2013, for generally healthy individuals.
• Breast cancer:
v For women aged 50 to 74 years, screening
mammography once every two years.
v For women younger than 50, the decision to start
regular screening should be an individual one.
• Cervical cancer:
v For women aged 21 to 29 years, a Pap test every three
v For women aged 30 to 65 years a Pap test every three
years or a Pap test and human papillomavirus (HPV)
testing every five years.
• Colorectal cancer:
v For adults aged 50 to 75 years, fecal occult blood
testing, sigmoidoscopy, or colonoscopy.
• Draft lung cancer recommendation:
v For adults aged 55 to 79 years, annual low-dose
computed tomography for those who have smoked one
pack per day for 30 years or equivalent (two packs per
day for 15 years, etc.).
Not listed are the screening programs the USPSTF believes
there is insufficient evidence to recommend for or against (e.g.,
screening for ovarian cancer).
However, high-risk individuals are the minority, so what
is to be done for the broader population? One approach to
identifying at-risk patients, as well as those with early-stage
disease, is to test generally healthy individuals for potential
disease through population-based screening programs (see
sidebar on USPSTF Cancer Screening Guidelines). These
programs largely function by using age and gender to grade,
or stratify, a person’s risk, with those identified as most at risk
being those who are most likely to benefit from the screening.
This approach to risk stratification has been extremely
successful for cervical cancer screening, as the program has
greatly reduced the incidence and mortality of cervical cancer
in the United States ( 76, 77). Further inroads against cervical
cancer incidence are likely given the dramatic reduction in
cervical infection with the cervical cancer–causing infectious
agent HPV among girls aged 14 to 19 years since the
introduction of the HPV vaccines ( 36).
Stratifying risk based on age has also worked for colonoscopy,
which has contributed significantly to dramatic declines in
colorectal cancer incidence and mortality ( 38). However, only
about 59 percent of all Americans aged 50 years and older,
the group for whom colorectal cancer screening is currently
recommended, get screened ( 78). Among the more than
one-third of Americans who do not follow colorectal cancer
screening guidelines is a disproportionately high number of
African-Americans ( 78, 80), a group that shoulders an overly
high colorectal cancer burden (see sidebar on Cancer Health
Disparities in America). Evidently, innovative ways to increase
the number of individuals, in particular racial and ethnic
minorities, following colorectal cancer screening guidelines